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Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related
Sustainable Development Goals for 195 countries and territories: a systematic analysis
for the Global Burden of Disease Study 2017.

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Abstract

BACKGROUND:Efforts to establish the 2015 baseline and monitor early implementation
of the UN Sustainable Development Goals (SDGs) highlight both great potential for
and threats to improving health by 2030. To fully deliver on the SDG aim of "leaving
no one behind", it is increasingly important to examine the health-related SDGs beyond
national-level estimates. As part of the Global Burden of Diseases, Injuries, and
Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health-related
SDG indicators and estimated the health-related SDG index for 195 countries and territories
for the period 1990-2017, projected indicators to 2030, and analysed global attainment.
METHODS:We measured progress on 41 health-related SDG indicators from 1990 to 2017,
an increase of four indicators since GBD 2016 (new indicators were health worker density,
sexual violence by non-intimate partners, population census status, and prevalence
of physical and sexual violence [reported separately]). We also improved the measurement
of several previously reported indicators. We constructed national-level estimates
and, for a subset of health-related SDGs, examined indicator-level differences by
sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments
of performance for selected countries. To construct the health-related SDG index,
we transformed the value for each indicator on a scale of 0-100, with 0 as the 2·5th
percentile and 100 as the 97·5th percentile of 1000 draws calculated from 1990 to
2030, and took the geometric mean of the scaled indicators by target. To generate
projections through 2030, we used a forecasting framework that drew estimates from
the broader GBD study and used weighted averages of indicator-specific and country-specific
annualised rates of change from 1990 to 2017 to inform future estimates. We assessed
attainment of indicators with defined targets in two ways: first, using mean values
projected for 2030, and then using the probability of attainment in 2030 calculated
from 1000 draws. We also did a global attainment analysis of the feasibility of attaining
SDG targets on the basis of past trends. Using 2015 global averages of indicators
with defined SDG targets, we calculated the global annualised rates of change required
from 2015 to 2030 to meet these targets, and then identified in what percentiles the
required global annualised rates of change fell in the distribution of country-level
rates of change from 1990 to 2015. We took the mean of these global percentile values
across indicators and applied the past rate of change at this mean global percentile
to all health-related SDG indicators, irrespective of target definition, to estimate
the equivalent 2030 global average value and percentage change from 2015 to 2030 for
each indicator. FINDINGS:The global median health-related SDG index in 2017 was 59·4
(IQR 35·4-67·3), ranging from a low of 11·6 (95% uncertainty interval 9·6-14·0) to
a high of 84·9 (83·1-86·7). SDG index values in countries assessed at the subnational
level varied substantially, particularly in China and India, although scores in Japan
and the UK were more homogeneous. Indicators also varied by SDI quintile and sex,
with males having worse outcomes than females for non-communicable disease (NCD) mortality,
alcohol use, and smoking, among others. Most countries were projected to have a higher
health-related SDG index in 2030 than in 2017, while country-level probabilities of
attainment by 2030 varied widely by indicator. Under-5 mortality, neonatal mortality,
maternal mortality ratio, and malaria indicators had the most countries with at least
95% probability of target attainment. Other indicators, including NCD mortality and
suicide mortality, had no countries projected to meet corresponding SDG targets on
the basis of projected mean values for 2030 but showed some probability of attainment
by 2030. For some indicators, including child malnutrition, several infectious diseases,
and most violence measures, the annualised rates of change required to meet SDG targets
far exceeded the pace of progress achieved by any country in the recent past. We found
that applying the mean global annualised rate of change to indicators without defined
targets would equate to about 19% and 22% reductions in global smoking and alcohol
consumption, respectively; a 47% decline in adolescent birth rates; and a more than
85% increase in health worker density per 1000 population by 2030. INTERPRETATION:The
GBD study offers a unique, robust platform for monitoring the health-related SDGs
across demographic and geographic dimensions. Our findings underscore the importance
of increased collection and analysis of disaggregated data and highlight where more
deliberate design or targeting of interventions could accelerate progress in attaining
the SDGs. Current projections show that many health-related SDG indicators, NCDs,
NCD-related risks, and violence-related indicators will require a concerted shift
away from what might have driven past gains-curative interventions in the case of
NCDs-towards multisectoral, prevention-oriented policy action and investments to achieve
SDG aims. Notably, several targets, if they are to be met by 2030, demand a pace of
progress that no country has achieved in the recent past. The future is fundamentally
uncertain, and no model can fully predict what breakthroughs or events might alter
the course of the SDGs. What is clear is that our actions-or inaction-today will ultimately
dictate how close the world, collectively, can get to leaving no one behind by 2030.
FUNDING:Bill & Melinda Gates Foundation.

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Assistant Professor of Environmental Health Science at Duke Kunshan University

My research interest is in the intersection of environment and population health.
Trained as an environmental epidemiologist, I am primarily interested in environmental
determinants of longevity. Second, given populations are living longer, how can we
delay neuro-degeneration and age-related diseases. Third, I am a proponent in applying
research for better policy-making to achieve SDG targets.